Alcohol Use Disorder, Comorbidity/Co-Occurring Disorders, and Treatment

"We generally found significant associations between 12-month and lifetime AUD and other substance use disorders, major depressive disorder, bipolar I disorder, specific phobia, and antisocial and borderline PDs when we controlled for sociodemographic characteristics and other disorders. Significant associations between persistent depressive disorder, posttraumatic stress disorder, panic disorder, and generalized anxiety disorder with lifetime AUD were also observed. That these associations were weaker than those when we only controlled for sociodemographic variables suggests common causal factors underlying the pairwise comorbid associations. Moreover, that these associations remained significant after additional control for comorbid disorders indicates the possibility of unique underlying factors contributing to the disorder-specific associations.47-49 These findings, consistent with genetic studies, highlight the need for further investigation of the unique and common factors underlying AUD comorbidity. Within this framework, special emphasis should be given to sociodemographic risk factors identified herein (education and income) that may interact with genetic vulnerability to influence phenotypic expression of AUD.

"Despite increased AUD prevalence during the past decade, this study showed that AUD largely goes untreated. Rather than lack of insurance, fears of stigmatization and beliefs that treatment is ineffective explain the lack of AUD treatment in the United States.50-54 Nonetheless, a large body of literature supports the effectiveness of treatment of AUD. Prior NESARC findings55 show that participation in 12-step groups increases the likelihood of recovery, consistent with randomized clinical trials testing the efficacy of 12-step facilitation administered by health care practitioners.56 Reviews and meta-analyses of randomized trials involving thousands of patients have demonstrated the efficacy of brief screening and intervention in primary care settings among individuals whose alcohol problems are not yet severe.57-60 For more severe problems, effective medications include oral and extended-release naltrexone hydrochloride, acamprosate calcium, and disulfiram61-65; evidence-based behavioral treatments include 12-step facilitation,56 motivational interviewing,66-68 and cognitive-behavioral therapy.68-70 Effective treatment might be more widely accessed if public and professional education programs targeted mistaken attitudes about treatment efficacy and provided information about where to obtain treatment.

"All measures of current disability were strongly related to 12-month AUD, increasing with AUD severity. These findings highlight the seriousness of AUD, particularly among never-treated individuals. Prior research has shown significantly less disability among those treated for an AUD than those never treated.71,72 When untreated, AUD-related functional impairment also has been associated with diminished life chances, increased stressful life conditions, and increased risk for and severity of other psychiatric disorders, even after AUD remission.73 These findings suggest that AUD treatment should aim to remediate impaired functioning in addition to targeting alcohol consumption."